Basic Information
| Provider Information | |||||||||
| NPI: | 1437614344 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIU-NGUYEN | ||||||||
| FirstName: | ALICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3120 FREEBOARD DR | ||||||||
| Address2: | |||||||||
| City: | WEST SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956915039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303517975 | ||||||||
| FaxNumber: | 5303517976 | ||||||||
| Practice Location | |||||||||
| Address1: | 9355 E STOCKTON BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956249476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166831109 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2019 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | CA | N | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.